October 7, 2003

Finding of Fact: Myth About Lung Cancer Can Be Deadly

By ANAHAD O'CONNOR

Herman Casey, who is 77, with his wife, Doris, said he once thought his lung cancer would spread if air reached it. "A lot of black people believe this," he said.

Some medical myths have been passed on through so many generations that quashing them can seem next to impossible.

One such myth, that lung cancer tumors spread when exposed to air, remains popular and could stop some Americans from agreeing to potentially lifesaving surgery, according to a study published this week in The Annals of Internal Medicine.

The idea is especially prevalent among African-Americans and could help explain their lower survival rates for lung cancer compared with whites, said Dr. Mitchell L. Margolis, the study's lead author and director of the pulmonary clinic at the Philadelphia Veterans Affairs Medical Center.

"A lot of people actually believe cancer spreads by contact with air," Dr. Margolis said, "and some will reject surgery they really need."

Twenty years ago when he started working at Philadelphia V.A., Dr. Margolis first heard patients balk at surgery out of fear of exposing their cancer to air. But as he heard the same objections to surgery through the years, particularly among African-Americans, he said, he decided to find out whether the belief was a local phenomenon or a widespread myth.

For about a year and a half, Dr. Margolis and his colleagues surveyed 626 patients at five pulmonary or thoracic surgery practices in Los Angeles, Philadelphia and Charleston, S.C., for a geographic mix.

They found evidence that the myth was fairly common. Nearly 40 percent of people surveyed said they believed that exposure to air in surgery caused tumors to spread. The major predictor of that belief, the researchers found, was race.

Sixty-one percent of African-Americans surveyed said they believed in the myth. The percentage among whites was half that. Even more worrisome, Dr. Margolis said, was that 19 percent of African-Americans cited the belief as a reason to reject surgery, and 14 percent said a doctor could not convince them otherwise.

The Philadelphia study found that education and income were also important factors in believing the myth, though race was the most striking factor.

Dr. Harold Freeman, director of the Center to Reduce Cancer Health Disparities at the cancer institute, said that education, income and race were tied together. He pointed to similar studies showing widespread belief in the same myth among poor whites of Appalachia.

Mythology is always built on experience, he said, so people who believe in the myth are basing it on personal experiences that they misunderstood. Poorer people generally have less access to proper health care and less trust in it, or they do not see it as a priority, he said. As a result, they are less likely to obtain early diagnoses.

"When a person comes into the hospital with late-stage cancer, it's often too late for doctors to do much," Dr. Freeman said. "So the community and the family see it only as the patient went into the hospital for surgery and died six months later."

Another possible factor is fatalism, something the American Cancer Society has tried to combat over the years, said Dr. Tom Glynn, director of science and trends at the cancer society.

"We hear people way too often say there is nothing that can be done to help them," Dr. Glynn said. "When they think that, they don't seek treatment soon enough, and they end up doing poorly."

Herman Casey, 77, said he was among the patients who believed that his lung cancer would spread if the air reached it. As a result, he felt that doctors could do little to save him.

"I always heard it growing up, that once you have the operation, the air hits it and it spreads," Mr. Casey, a patient of Dr. Margolis, said. "A lot of black people believe this."

It was only after Dr. Margolis insisted on the advantages of surgery that Mr. Casey agreed to it last year.

"He said if I was his father, he would make me have the operation," Mr. Casey recounted. "I figured if I don't have the operation, I'm going to die anyway. So I took a chance and had it."

Dr. Margolis wants to conduct more comprehensive studies about other myths about lung cancer.

"This is just the main one that's been voiced to me," he said. "Some people won't even accept that smoking causes cancer or that quitting decreases your risk."